For the majority of our patients who have a preferred language other than English, seek-ing health care can be an anxiety-

provoking event. Will they be seen by a provider who listens and understands them? Will they receive the same quality of care and communication as those who speak English? We owe it to our patients to make sure language is not a barrier to receiving exceptional care. A core element of the solution is making sure that we have interpreters available in person or by phone/video at all times. As I’ve shared in prior issues, this is a big focus area for DHS and we have invested heavily in building up our staffing and improving our practices in this ar-ea. There is no better time to say thank you to our fan-tastic interpreter staff as they celebrated International Interpreter’s Day on Sept 30th. We are indebted to your passion, skills and cultural intelligence. Among other areas of progress in DHS, turn your attention to the results of this year’s Just Culture Pulse Survey. Particularly impressive is the increase (by

19%!) of those who feel they have a good understanding of Just Culture. Awareness and understanding is a criti-cal first step. We will continue to work to embed the principles of Just Culture – principles of fairness, ac-countability, and systems-thinking across all levels of the organization. I encourage you to continue to look for ways to learn about and apply Just Culture principles where you work. To learn more, please visit the Just Culture DHS website. Finally, this month’s issue highlights two hid-den jewels of DHS: Juvenile Court Health Services and their work on combatting Commercial Sexual Exploita-tion of Children, and DHS’ own Emergency Medical Ser-vices (EMS) Agency, which is the focus of this month’s Spotlight. In so many ways, we all benefit from the EMS Agency’s work in coordinating and regulating emergency medical services in the County. This impact is felt far and wide, the breadth of their responsibilities is remarka-ble. They coordinate pre-hospital care, designate spe-cialty centers for such conditions as stroke and myocar-dial infarctions, manage the County’s trauma system, oversee ambulance transport, manage paramedic and EMT training programs and serve as a key agency in the County’s disaster preparedness infrastructure. My thanks to the entire EMS team for their work in service of residents County-wide. We are so glad you are part of the DHS family!

September 30, 2019

• September 30th: Happy Interpreters / Translators Day!

• LA’s Story – Juvenile Court Health Services

• Bubbles!

• 2019 DHS Pulse Survey Results

• Rancho Embraces Diversity

In This Issue

September 30th: Happy Interpreters / Translators Day!

Ne

ws

The Pulse keeps you connected to all that is happening across DHS. Please contact the editors with suggestions for articles.

Christina R. Ghaly, MD

Director

Director’s Desk

Page 1

By Nina Vassilian, MPH, MCHES In recognition of our DHS-wide Healthcare Interpreters

As September 30th marked the International Observance of the Interpreters / Translators Day, the Office of Di-versity, along with our Limited English Proficiency (LEP) Administrators throughout DHS Hospitals and Ambulatory Care Network (A.C.N.) facilities, extend our sincere appreciation for all the hard work our Healthcare Interpreter staff do every single day of the year. The ongoing dedication of our Interpreters demonstrates pride and commitment to the very respectable profession of Healthcare/Medical Inter-pretation.

What is the Role the Healthcare Interpreters Play in DHS’ Service Delivery?

Healthcare Interpreters play a key role in DHS’ service delivery system, partnering with our medical providers to provide excellent care to our patients, with the aim of earning DHS the title of “Provider of Choice”. Healthcare Interpreters are a vital part of the DHS care teams serving our pa-tients representing a wide range of language, ethnic, and cultural backgrounds. Improved patient care interactions are identified by the following key elements:

• Improved quality in the delivery of care

• Improved patient safety compliance

• Improved patient adherence with the med-ical regimen

• Improved patient experience and customer satisfaction

Patient & Clinician Success Stories

What a Healthcare Interpreter does - From a Patient’s own words:

"After my total hip replacement, I wasn't able to walk normal-

ly or sit. As soon as Rancho provided me the assistance of Mikayel, a Healthcare Interpreter, I was able to share my thoughts and worries with someone who understood me. Mikayel advised me on who to talk to and what my options were. He gave me direction in dealing with my health situation. Mikayel was able to describe my situation to the phys-

ical therapist, and the therapist was able to give me a much speedier appointment. Since starting the therapy, my condition has improved greatly, and as I continue to receive therapy, I continue to improve. Because Mikayel understood my language and my pain, he was able to give me direction and hope, and mediated the situation so that I could receive the appropriate care. I am lucky and grateful for the services of Mikayel and the wonderful help I re-ceived at Rancho."

What a Healthcare Interpreter does - From Sarah Gustafson, MD, Harbor-UCLA Medical Center:

“On the pediatric ward, we were caring for a young girl who unfortunately needed an appendectomy on her birthday, but the surgery went very well. The girl spoke English, but her father spoke only Spanish. Victor Quiroz, one of our Harbor-UCLA HCI and the Language Center Coordi-nator, came to provide in-person simultane-ous interpretation for our morning family-centered rounds. This enabled the team to seamlessly communicate with both the pa-tient and the family in both Spanish and Eng-lish. We were able to provide the good news about going home, discharge instructions, and meaningfully answer all of their ques-

tions. After rounds, her father was beaming. When asked what the interpretation service meant to him, he said: “…Some of us don’t speak English… It’s not enough to understand just half, to have to guess the other half. You have to understand everything, because it’s about the health of our loved ones.”

Be sure to thank your local Healthcare Interpreter today!

Robin Young Editor

Connie Salgado-Sanchez Co-Editor

Init

iati

ves

Page 2

By Charmaine Dorsey, MSW, LCSW and Anna Gorman When is the last time you blew bubbles? Did you know that it can be used to decrease stress, anxiety and worry? A medical case worker at one of our DHS health centers is changing her patients’ lives with a simple, low cost and effective technique. And all it takes is a bottle of bubbles. The medical case worker, Karineh Mahdessian, invites pa-tients – some experiencing anxiety and distress – to blow bubbles dur-ing mindfulness breathing exercises. “It works wonders,” said Mahdes-sian, a medical case worker at Hubert Humphrey Comprehensive Health Center. The bubbles are one small and innovative part of behavioral health integration, a project that launched at seven DHS primary care medical homes in April. The teams are using a variety of techniques to engage patients, teach self-care and address mental health, substance use and social needs such as housing, food insecurity and transporta-tion. Mahdessian said blowing bubbles is making a difference for her patients, including one woman with depression who cares for a 3-year-old granddaughter on the autism spectrum. Mahdessian used the collaborative care model to establish a rapport with the patient. She

also introduced her to mindfulness breath-ing – and explained how breathing can change through blowing bubbles. The patient, who shared the bubble blowing with her non-verbal granddaughter, said it brought back childhood memories. The patient also said she feels better after she blows bubbles and that it brings her joy to share this with her granddaughter. Mahdessian keeps bubbles in her office and often asks patients to blow bub-bles with her as a way of relaxing and breathing. In addition to bubbles, Karineh has used a variety of other tools and tech-niques to encourage self-care and mindfulness, including affirmations and essential oils. Now, even staff members are pulling out their bubble wands when they feel stressed. “The feedback I received from my patients encouraged me to coordinate and facilitate a bubble party for our staff at Humphrey,” she said. During the party, she said the staff also learned how to mindfully breathe. Mahdessian said bubbles have proven to be a remarkable, accessible tool that makes everything fun (and soapy).

By Marya Monares, MD After attending the launch of Los Angeles County’s First Responder Program, our Juvenile Court Health Services (JCHS) Medical Director and two pediatricians at-tended a Nola Brantley Speaks Commercial Sexual Exploitation of Children (CSEC) 101 Training. Recognizing a call to action, the JCHS Nurses and Physicians CSEC Champions Committee was formed in 2014. Our dedicat-ed team collaborated with local partner agen-cies and national experts. Together, we de-veloped the JCHS Policy on CSEC with the purpose of outlining healthcare practices for detained victims and survivors of commercial sexual exploitation (CSE). JCHS seeks to en-sure that these youth receive whole person support and appropriate medical attention. As per the JCHS Policy, physicians shall receive CSEC training as new hires and follow-up CSEC training every 2 years thereaf-ter. JCHS understands that an individual’s medical care is only one aspect of a person’s wellbeing, and that a person’s history of CSE is only part of their story. Representatives from our Department have sat at the table with Michelle Guymon, Director of Child Trafficking Unit (CTU), and her team to help develop the Interagency Detention Protocol for CSE Children and Youth. JCHS is committed to continue working with our community partners and surrounding each youth with a village of support.

“For far too long, medical providers had the privilege of listening to the stories and seeing the wounds of our CSE youth with-out knowing how to meet their needs. Our youth were being re-victimized unknowingly by a system untrained to help them. Nola's CSEC 101 training put everything I had wit-nessed into a clear perspective. Nola gave me the tools to start my journey with an amazing group of people, with our youth at the helm. Together, we’ve been able to create change. I’m so grateful. And we’ll continue the good fight as advocates for our youth.” – Dr. Marya Monares, JCHS Nurses and Physicians CSEC Champions Committee Chairperson. “JCHS is proud of its healthcare providers for their dedication and commitment to providing the

best possible care for all of our youth. Our JCHS Nurses and Physicians CSEC Champions Committee has led the way in not only guiding our staff on the identification and response to CSEC, but also in shifting the culture surrounding CSEC.” – Dr. David Oh, JCHS Interim Medical Direc-tor. “As nurses we have the tools and responsibility to help sexual-ly exploited youth overcome their current circumstances and be their liaison by connecting them with the resources LA County has to offer,” - Alma Otey, RNI. For more information, contact: Juvenile Court Health Services Interim Medical Director David Oh, MD at doh@dhs.lacounty.gov or (323) 986-2240.

LA’s Story – Juvenile Court Health Services

Photo - Back row: Sandra Lopez, RN, Lynn Matthews, RN, Marcia McKeever, RN, Alma Otey, RN; Middle row: Alma Kucenski, RN, Maria Whitfield, RN, Marielle Parrillo, RN, David Oh, MD; Front row: Lynne Ticson, MD, Marya Monares, MD, Felita Thompson, MD Not pictured – Cornelia Freudenstein-Licona, MD, Shatuaqua Draper, RN, Soledad Martinez, RN, Crystal Jurado, RN

Aro

un

d D

HS

Rancho Embraces Diversity

By Lily Wong, MA, MBA

Rancho Cultural Diversity Operations Council and LGBTQ Committee hosted the Interpreter/Translator Day and Bisexual Visibility celebrations along with the Hispanic Heritage Month cele-bration on September 4th at Don Knabe Plaza. Mr. Ben Ovando, Chief Operations Officer, provided a welcome speech, with music entertainment by Rancho Performing Arts. Useful cultural re-sources on Hispanic countries, information about interpreter ser-vices and Bi Visibility were distributed and well received by staff, visitors, patients and families who attended the celebration.

Bubbles!

2019 DHS Pulse Survey Results

By Marife P. Mendoza, RN, BSN, MBA-HCM Thank you for taking part of the recent DHS Pulse Survey. The ac-tivity was part of DHS ongoing efforts to track our progress in our Just Culture journey. The survey provided an opportunity to rate your understanding of Just Culture, the ease of speaking up about errors and mistakes and your perception of fairness in the work-place. The many and continuous Just Culture in-person and online-based trainings provided have significantly increased the total num-ber of staff who have a good understanding of Just Culture. DHS has improved its overall percent favorable (strongly agree + agree) responses in all survey questions. You can review the overall DHS and facility specific survey results here. In addition, see the info-graphic on the third page for overall DHS, DPH and DMH summary results. Again, thank you for your survey participation and contin-ued support in creating a just and fair work environment allowing us to provide great service and safe care to our patients every day.

13,178 Health Agency staff

responded to the Pulse Survey

66%

2019 JUST CULTURE PULSE SURVEY

Respondents said that "in my work unit, I am treated fairly."

86%Respondents said they

had a “good understanding of

Just Culture.”

55%Over half of the

respondents agreed that "managers respond

appropriately to employees whose

behavior or performance fails to meet expectations."

Thank You for participating in Just Culture training and responding to our survey. Your voice matters: Stay engaged!

63%Respondents answered

positively to the statement, “It’s easy to speak up about errors

and mistakes."

September 2019

41%

Respondents said that "when an error or mistake occurs,

managers look at both employee

actions and operational issues."

64%Respondents said their "managers

emphasize learning rather than blaming

when staff makes mistakes."

63%

ORTotal Employees: 32,011

We’re making clear progress on Just Culture, our number one Labor Management Partnership priority.

SPOTLIGHT DHS

September 2019

The EMS Agency ensures timely, compassionate and quality emergency and disaster medical services are provided throughout the County.

Prior to the establishment of the official EMS System in 1970, there was no consistent method for responding to sudden injury and illness. The patient may have self-transported to a local physi-cian office or hospital, bystanders may have rendered care and/or transportation; local physicians may have visited the patient at home; or an ambulance usually owned by a mortuary, may have been called to take the patient to a nearby hospital. The mecha-nism of transport and treatment of emergency patients varied from city to city and often neighborhood to neighborhood.

During this time, the pioneers in EMS were looking at ways to im-prove this situation and develop a mechanism to ensure rapid transport and treatment for emergencies with all patients being delivered to a hospital. People such a Dr. J. Michael Criley, Dr. Walter Graf and Supervisor Kenneth Hahn blazed this path setting the foundation for the EMS system and 9-1-1 response we all now take for granted. The EMS Agency ensures that the emergency care provided to the public is coordinated such that no matter where you live in Los Angeles County, if and when you have an emergency, the access to, and the care provided will be the same.

The Los Angeles County EMS Agency is one of 33 local emergency medical services agencies in the State. The EMS Agency is responsible for the coordina-tion, planning and regulation of the countywide EMS System. This includes the following activities:

• Designating hospital specialty centers to include Trauma – Adult and Pediat-ric, ST Elevation Myocardial Infarction, Cardiac Arrest, Stroke – Primary and Comprehensive, Emergency Departments Approved for Pediatrics, Pediatric Medical Centers, Sexual Assault Response Team providers and Hospital Pre-paredness Program participant.

• Providing medical control and assuring medical accountability throughout the EMS system through the development of treatment protocols and medi-cal control guidelines used by the over 4,000 licensed paramedics, 8,000 emergency medical technicians (EMT) and 800 Mobile Intensive Care Nurs-es (MICN) in providing care to persons who call 9-1-1 and on-going quality improvement and research.

• Licensing of private ambulance companies

Why is the Emergency Medical Services (EMS) Agency Important to us?

What is the Emergency Medical Services Agency?

Emergency Medical Services Agency

It takes everyone who works at the EMS Agency and the 29 jurisdictional fire departments, 25 private ambulance companies and 72 hospitals with emergency services working together to ensure that the EMS system meets the needs of emergency patients. Cathy Chidester, Director and Marianne Gausche-Hill, MD, Medical Director lead this effort along with the sup-port of the Assistant Directors, Roel Amara, Kay Fruhwirth and Richard Tadeo and the Assistant Medical Director, Nichole Bosson, MD.

For more information on this publication, contact communications@dhs.lacounty.gov

What has been the impact?

Where do we go from here?

Acknowledgments

The medical policies and protocols established by the EMS Agen-cy have improved the outcomes and lives of millions of patients in the prehospital setting over the last 50 years. Los Angeles Coun-ty’s regionalized systems of emergency care include Trauma, Stroke, STEMI, Cardiac Arrest, Pediatric and Disaster care. These systems are nationally recognized and the program data are fre-quently presented in academic publications or at State and Nation-al conferences. We are proud of our accomplishments and suc-cesses, which are only possible through the hard work and dedica-tion of EMS Agency staff and the support of the Department of Health Services and the Board of Supervisors.

• Certifying EMTs and taking disciplinary action on their certification when indicated, certification of MICNs and local ac-creditation of paramedics

• Approving paramedic, EMT, public safety and continuing education training programs

• Managing the physician and hospital reimbursement programs for indigent emergency care

• Coordinating healthcare disaster preparedness, response and recovery activities

In addition, to these regulatory roles the EMS Agency also is responsible for the coordination of patient transfers through the Medical Alert Center (MAC) and ambulance transportation for DHS.

With better data and increase in the amount of research, along with new medications, equipment, and technology, the future will contin-ue to call for changes in prehospital care practice. However, the cornerstone of prehospital emergency care is truly the frontline par-amedics, EMTs and hospital emergency departments who play a vital role in the safety net of emergency services for the County. Los Angeles County will continue to be a leader in EMS.